Comparing 10-Year Follow-up Outcomes Among Patients Without Unstable Chondral Lesions Versus Those With Unstable Chondral Lesions (Left In Situ) at the Time of Arthroscopic Partial Meniscectomy

Abstract

Background:

The Chondral Lesions and Meniscal Procedures (ChAMP) trial observed the effect of debridement on unstable chondral lesions (CLs) encountered during arthroscopic partial meniscectomy (APM) while following a cohort with no CL to compare outcomes. At 5 years after APM, patients in the ChAMP Trial without unstable CLs had better outcomes than those with unstable CLs left in situ.

Hypothesis:

Patients without unstable CLs would have better outcomes than those with unstable CLs 9 years after APM.

Study Design:

Cohort study: Level of evidence, 2.

Methods:

The authors compared outcomes for patients with unstable CLs found at the time of APM and not debrided (CL-NoDeb; n = 64) versus patients without unstable CLs (NoCL; n = 51) 9 years after APM. Outcomes collected in patients who did not have subsequent knee surgery included patient-reported outcome measures (PROMs), physical examination measurements, and radiographic joint space narrowing. Multivariate linear regression was used to obtain mean differences (MDs) with corresponding 95% CIs adjusted for age, body mass index, and preoperative score (for postoperative scores) while using multiple imputation to account for loss to follow-up.

Results:

At 9 years after APM, no group differences were found in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scores or other PROMs in patients who did not have subsequent knee surgery. However, a significantly lower rate of subsequent surgery was seen in the NoCL group compared with the CL-NoDeb group for the index leg (NoCL 2.0% vs CL-NoDeb 21.9%).

Conclusion:

The authors compared outcomes at nearly 10 years in patients with and without unstable CLs who underwent APM and found a significantly higher rate of subsequent arthroplasty in those with unstable CLs (21.9% vs 2.0%). Patients who avoided arthroplasty had equivalent PROMs and minimal progressive joint space narrowing on weightbearing radiographs.